Provider Demographics
NPI:1467679217
Name:DRANGE, STUART SUMNER (DDS, FICOI)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:SUMNER
Last Name:DRANGE
Suffix:
Gender:M
Credentials:DDS, FICOI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 MAIN STREET
Mailing Address - Street 2:HWY 395
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410
Mailing Address - Country:US
Mailing Address - Phone:775-782-7169
Mailing Address - Fax:775-782-7215
Practice Address - Street 1:1480 MAIN STREET
Practice Address - Street 2:HWY 395
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410
Practice Address - Country:US
Practice Address - Phone:775-782-7169
Practice Address - Fax:775-782-7215
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
88-0177179OtherTAX I.D. NUMBER